Nonconventional Approaches in Psychiatric Assessment

A future, more integrative psychiatry will include an eclectic and sophisticated array of individualized assessment and treatment approaches that are capable of addressing symptoms of mental illness at disparate biological, informational, and energetic levels of the body, brain, and mind. Although quantitative electroencephalography (QEEG) analysis has become an important research tool in psychiatry, this technique is not yet widely used in conventional psychiatric assessment. Thus, for purposes of this discussion, QEEG is regarded as a nonconventional approach.

Emerging evidence suggests that ultraweak biophotons may be useful indicators of illness. Serological and urinary assays used in functional medicine are increasingly being applied in clinical settings. Assessment approaches that purport to detect subtle forms of energy not described by Western science are also being widely used by alternative medicine practitioners to evaluate persons who present with mental health issues. These techniques include pulse diagnosis in Chinese medicine, Ayurvedic and Tibetan medicine, and analysis of the vascular autonomic signal (VAS).

Some approaches will be scientifically validated by future research findings while others will be refuted. The increasing use of novel assessment approaches in Western psychiatry will permit more comprehensive and cost-effective treatment planning because accurately characterizing the underlying causes of symptoms will point to the most appropriate and effective biomedical or nonconventional treatment. In this article, I briefly review approaches that are being used to assess psychiatric disorders but that are not currently in use in conventional Western psychiatry.

Nonconventional assessment

Chinese, Ayurvedic, and other non-Western systems of medicine rest on assumptions that are fundamentally at odds with the philosophical position of Western biomedicine, which argues that the causes of illness are reducible to identifiable physical or biological factors. In contrast, Asian healing traditions assume that complex, nonlinear energy-information processes play important roles in illness causation, and that a person's intention has direct and in some cases nonlocal effects on health and illness. This model argues that health and illness are manifestations of complex dynamic interactions among psychological, physical, biological, social, energetic, and spiritual factors at multiple hierarchical levels of organization in space and time.1

In contrast, biomedical psychiatry posits that discrete causes of symptoms are biological processes that manifest as depressed mood, varying degrees and severity of anxiety, impaired cognitive functioning, and so on. In this conventional model, indirect causes of symptoms include acute or chronic social, cultural, or psychological stresses that lead to changes in specific biological (including neurobiological and endocrinological) systems that ultimately manifest as symptoms.

Integrative medicine begins with classic neurophysiology and extends the conventional explanatory model to include putative causes of symptoms that are "energetic" or "informational" processes. This model suggests that these disparate processes affect the body, brain, and mind at various levels in a dynamic, web-like hierarchy of structure and function that includes the neuroendocrine system; immune system; highly organized biomagnetic fields generated by the brain and heart; and possibly nonclassic energy-information processes, including large-scale coherent quantum fields and other subtle energetic or informational phenomena associated with human consciousness. In this broad context, the goals of integrative mental health care include accurately characterizing the causes of symptoms and constructing treatment strategies that effectively address those causes.

Benefits of integrating nonconventional approaches in psychiatric assessment include the following:

Clarification of the psychiatric differential diagnosis when conventional assessment methods have failed to identify the causes of a symptom or disorder or when the patient's medical or psychiatric history is vague or complex.

Combining conventional assessment methods with nonconventional biological assessment approaches based on current medi- cal theory—including QEEG and urinary or serological studies of neurotransmitter metabolites, im- munological, or endocrinological factors—may result in increased specificity and accuracy when ruling out postulated biological causes or markers of mental illness.

Combining conventional assessment methods with emerging approaches currently outside biomedicine will clarify the role of putative energetic causes of mental illness. At present, limited data support the use of most nonconventional assessment methods, and those approaches that have been rigorously evaluated using Western-style research studies have not yielded reproducible, sensitive, or specific findings.2 Nonconventional assessment approaches that have not been found to provide useful diagnostic information on the basis of Western-style research studies include iridology, hair analysis, kinesiology, radionics, clairsentient diagnosis, and electroacupuncture, according to Voll.2 Instead of reviewing negative findings of approaches that are dubious, I will focus on a few promising assessment approaches for which there is significant emerging evidence. The perspective of integrative medicine is that both biomedical and nonconventional assessment approaches should be considered, depending on the relative strength of evidence, availability, cost, and patient preferences. Categories of nonconventional assessment Assessment approaches that are not routinely used in conventional biomedicine to assess mental illness in patients can be assigned to 3 general categories.